Domestic violence: changing theory, changing practice

Despite widespread recognition of domestic violence as a public health problem, many clinicians still have difficulty integrating routine intervention into their day-to-day practice. This is in part because domestic violence raises a distinct set of challenges for both providers and the institutions that shape clinical practice. Domestic violence is a complex social problem rather than a biomedical one; addressing it means asking clinicians to step beyond a traditional medical paradigm to confront the personal feelings and social beliefs that shape their responses to patients and to work in partnership with community groups committed to ending domestic violence. In addition, addressing domestic violence raises important challenges to the health care system itself-to its theoretical models, to the nature of medical training, and to the rapidly changing structure of clinical practice. If we truly want to play a role in preventing domestic violence, rather than just treating its consequences, we must work together to transform both the individual and social conditions that create and support this kind of violence in the first place.